Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hello doctor,
I am a 34 years old female, 5'4 "in height and weighing 121 Ibs. I have pain in the right elbow joint, and knuckle joints of my right hand. There is also constant pain in both knees, and it is difficult and painful to sit and get up. Squatting down and getting up is quite painful. ESR test done about 10 days shows a value of 60mm/hr. MRI was also done in relation to back pain, and the diagnosis was osteoarthritis. I do not take any medication. Kindly guide me on what it could be.
Hello,
Welcome to iclniq.com
I read your query and understand your concern. You are having inflammatory polyarthritis. You will need some more investigation in order to confirm the exact type like rheumatoid arthritis or reactive arthritis or idiopathic polyarthritis. Did you have any urinary or intestinal infection prior to the onset of arthritis, if yes it points towards reactive arthritis. I assume there are no symptoms like sensitivity to light, rash over the face, anemia, or recurrent oral ulcers, other than pain and spasm in fingers. You should get a serum ANA (antinuclear antibody) test, rheumatoid factor, and anti-CCP (cyclic citrullinated peptide) test done. Also, vitamin D levels. You could visit a nearby laboratory or rheumatologist for the same. Till the time your evaluation is complete, I suggest taking a tablet of Indocid (Indomethacin) SR 75 mg once a day after breakfast along with a tablet of Pantoprazole (pantoprazole sodium) 40 mg before breakfast for one to two weeks. We will start specific treatment according to the cause. Hope this helps you get back if you have any doubts.
Thank you.
Patient's Query
Hello doctor,
Thank you for the response. The spasms have not happened recently. But I have had a history of spasms in reaction to cold weather since childhood. I did not have any urinary or intestinal infection prior to the pain starting. Also, I do not have other symptoms like sensitivity to light, anemia, or rash on my face. I got my vitamin D and Hb (hemoglobin) levels checked two weeks ago in connection with the back pain. Both were within range. I had low vitamin D (8 ng/mL) and B12 levels and was on medication for both vitamins for a couple of months after that. Now both B12 and D levels are good. I also have pain in my toes (feels like swelling but I do not see any visible swelling).
Hello,
Welcome back to icliniq.com
It is fine to have this spasm also called Raynaud's phenomenon. Toes pain is also probably a part of polyarthritis. You should start the anti-inflammatory medicine which I mentioned earlier and look for the response.
Thank you.
Patient's Query
Hello doctor,
I got the tests for arthritis done. Everything shows in the normal range.
Hello,
Welcome back to icliniq.com
It is a good thing that the workup is negative. even ESR (erythrocyte sedimentation rate) is normalized. This indicates that you do not have any major arthritis and this was probably a post-viral joint pain. The infection has settled as esr is normalized, and post-viral pain may continue for some time. You continue the tablet Indocin for two weeks, and if it does not settle then you will get some more medicine like a tablet of Sazo (Sulfasalazine), which we can add after some days. Get back if you have any more doubts.
Thank you.
Patient's Query
Thank you, doctor.
The pain and swelling in the toes have increased slightly but knee pain is slightly better. I just remembered that I did have some unexplained rash on both palms. Could it be a viral infection?
Hello,
Welcome back to icliniq.com
Certainly, it could be a viral infection, and most probably should settle soon.
Thank you.
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Cardiology
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